Translating to save lives

The Richmond High School students gather around the new poster, studying it closely. “It says something about an epidemic,” says a tall girl with red hair. She turns to the others with a worried look. If only she had paid more attention in French class.

“Yes,” the boy next to her concludes. “It says we’re supposed to, uh, do something.” His voice trails off.

“No, it doesn’t,” a third teenager in braces corrects him. “It says we’re not supposed to. . . .” She turns to her friends for help. They shrug and return to the poster. It’s clearly important, but they are unable to make any sense of the foreign words. No one asks, “If the information is important enough to warrant a sign outside their lunchroom, why isn’t it in English?” They look from one to another as more students come down the hall to peer at the poster.  

Full disclosure: The Richmond High School students and the pandemic poster are made up, but just imagine if it were all true. Without translation, how could those students possibly know how to avoid being infected?

While this absurd situation may be fiction for us, it most definitely isn’t for up to four-fifths of the world’s population. It would seem like science fiction if a pharmacist were to hand out a prescription with directions in Esperanto. Yet the everyday reality for billions of people in the world’s poorest countries is that critical health information, such as how to protect themselves against the AIDS pandemic, is inaccessible to them because it’s locked up in a language they don’t speak.

I myself witnessed just such a scene in one of the villages I visited in Kenya a few months ago. An isolated village four hours from Nairobi along a road choked with long-haul truckers, Thange is desperately in need of translation. Accompanied by an interpreter from Nairobi, I met with the people of the village. Some of them were orphans who are HIV positive and living with their widowed grandmothers or alone in households where the oldest family member is a sibling as young as ten.

Many of the Thange villagers, particularly the orphans and other vulnerable children, were clearly in poor health. Eight-year-old Mazoki, who is HIV positive, coughed continuously as she sat on a bench beside me, bending a head covered with small sores. Next to us, children — either infected by AIDS or orphaned because of it — played in front of a poster on the wall that spelled out how to protect themselves against the disease. Neither they nor the adults could read it.


The disease burden in Africa

Like nearly everywhere in Africa, while the poor health of Thange’s people is partly due to AIDS, the village also has to contend with a lack of clean drinking water, inadequate sanitation and a shortage of food (they refer quite matter-of-factly to the season known as the hungry time). Unchecked malaria, parasites and indoor cooking fires also place a higher disease burden on these Kenyans and especially on the children.

Africa carries approximately 25% of the world’s disease burden, but to address this, the continent has 2% to 3% of the world’s doctors and nurses. Aggressive recruiting of high-level medical staff by the wealthiest nations is one of the main reasons why health care in Africa is largely dependent on community health workers. These health care workers may be young or they may be old, they may be illiterate or they may be educated. But one thing is certain: They are not fluent in English.

This may not seem like much of a problem — except that their medical training is often delivered not in their local language or even in a lingua franca such as Kiswahili, but in English. This influences the quality of training for health care workers who shoulder a large burden for providing health care in a situation that combines a high rate of disease with a low rate of doctors and nurses. For the people of Thange, the nearest hospital is hours away, and transportation is expensive. Even children living with AIDS such as Mazoki only get to the hospital once a month, if they’re lucky, for the antiretroviral treatment that will keep them alive. The rest of the time they, like the other villagers, must rely on visits from the community health care worker.

When I visited the village’s new dispensary built with funds from the Canadian International Development Agency, I saw no medicines and no bandages, just a well-thumbed community health manual and a couple of posters up on the outside wall. The posters described how to avoid AIDS and cholera and what to do in the event of malaria. But everything was in English, even though the first language of everyone in the village is Kikamba and Kiswahili the second, with English a very far third. This is the situation being played out every day in villages, not only across Kenya but across the whole of Africa, where critical information is trapped in a foreign language. The consequences are all too predictable. One-fifth of all African children will die before their fifth birthday, to give just one example, and most of them will die needlessly since the ways to save them are well documented.

The truth is that millions of children die each year from nothing more than a lack of knowledge. James Grant, former head of UNICEF, estimated that 90% of the children who died during his tenure died because the knowledge to save them wasn’t available where and when it was needed. According to Neil Pakenham-Walsh of the Global Healthcare Information Network, “a major contributing factor is that the mother, family caregiver or health worker does not have access to the information and knowledge they need, when they need it, to make appropriate decisions and save lives.” The organization goes on to detail some of the ways the lack of information costs lives:

Seven in ten children with malaria cared for at home are given improper treatment (2,000 deaths every day in Africa alone).

Four in ten mothers in India believe that they should withhold fluids if their baby develops diarrhea (1.8 million deaths every year from dehydration due to diarrhea).

Seven in ten women giving birth in health facilities in Africa and South Asia are incorrectly managed during the third stage of labor, leading to postpartum hemorrhage (500 maternal deaths every day).


‘Everyone speaks English’

So why do the countries with the highest disease burden and the fewest health resources have so little access to medical support in their languages? We in the translation industry know all too well the small mindshare translation occupies in general, so it is sad, but not surprising, to see that language is quite simply not an issue for many non-governmental organizations (NGOs) operating in the developing world.

This could be due to a phenomenon we call “Everyone speaks English,” though nothing could be further from the truth. Even in India, an ex-British colony, only around 14% of the population speaks English. Where does the misconception of the universality of English speakers come from? It could be that the 86% of Indians who don’t speak English live in the rural areas and, as such, are invisible.

We’ve also heard it said that everyone speaks English in Kenya, and, yes, they do speak a beautiful English in Nairobi, with a mellifluous accent that is a sheer pleasure to listen to. But the farther you stray from the cities, the less proficient the English until you reach villages where no one speaks it at all.

If NGOs and the donors who support them are unaware of the high cost of neglecting local languages, the same cannot be said of grassroots African groups. Speaking to African humanitarian medical publishers on the ground, it was obvious that translation is indeed an issue for them, but, alas, it is also outside their means. Because of a shortage of professional translators in many African languages, per-word prices can go as high as $3. At these levels, most organizations — for profit or nonprofit — simply don’t translate their content, which leads to word prices staying high and putting translation out of reach for the health care and corporate sectors alike. A vicious cycle is thus created. The high rate actually limits demand, meaning there is less work to encourage a new generation of Africans to become translators. This also handicaps companies. There are notoriously few trained African language translators to meet the demands of global companies such as Google and Microsoft, even when they are ready to pay the local price. 

Translators in Africa face multiple barriers to entry. One, ironically, is the scarcity of constant and thus well-paid translation assignments, which leads to many translators having to have day jobs and translate in the evening or on the weekend. Says Evelyne Iminza, a Kenyan translator, “I have a regular 8-to-5 job, and I do translations on the side. At times my job requires me to travel to some remote areas of the country, and if I have a translation to do, the task becomes very arduous since some areas have no internet connectivity.” This sentiment is echoed by the manager of Tamarind Translations in Nairobi, Theo Marube: “In the face of unpredictable income from translation work, Kenyan translators are unable to invest in relevant training and equipment, including the inability to buy new and well equipped computers/laptops, as well as translation and other word processing software.”

Internet connectivity is yet another substantial hurdle for African translators. “In Kenya, most translators rely on cybercafés since the cost for domestic installation of the internet is prohibitive and infrastructure limited to the main towns. Modems are the only option, but these do not provide broadband and are very expensive,” continues Marube. “Cybercafés tend to be unreliable in terms of connectivity and ill-designed to provide a conducive environment. Consider the opening and closing hours, limited additional word processing and text exchange software and erratic connection, the noisy environment and risks for viral attacks and corruption of translated files.”

Within the next 24 months, a connectivity solution may be on its way. Google’s O3B project — for the Other 3 Billion — will start to come on-stream, with low-orbit satellites linking the developing world to the internet.

Rachel Ndichu, a freelance translator working out of Nairobi, sees the lack of support organizations as another challenge for African translators. “To begin with, the education system or institutions have not given this field ample exposure. This means that few people know about translation, and since the institutions have not been keen on offering courses specific to the area, we have fewer properly trained and informed translators. In addition, there is no existing and well-established body for translators which would greatly help in providing information on the field. Without such a body and with the few existing translators hardly interacting, there is no clear guide on how to charge for work; thus, young translators really struggle with quoting rates to their clients.” Ndichu also sees the need for training to enhance translators’ skills and the need for free CAT tools licenses.


ELM program

Let’s go back to our fictitious Richmond High School students. If we really wanted to help them understand how to protect themselves against AIDS, wouldn’t we want to be darn sure they understand the information we’re giving them? And isn’t that equally as important when teaching sex education to teenagers half a world away?

Translators without Borders, a nonprofit providing free translations to humanitarian organizations, is trying to help lift some of these barriers to freely available medical information for all Africans. Looking to increase the pool of professional translators in local African languages, we are developing a program called Emerging Languages Mentoring (ELM) to help foster a locally based translation industry in the continent. With support from partners across the translation industry such as, Google, Wordfast and acrolinx, ELM will make training and tools available to African translators. Once funding is in place, other actions will include enabling mentoring relationships with individual translators and translator associations and helping to arrange for laptops and internet connections in exchange for the translation of health materials. How will we know we have made an impact? When local African translators can help provide medical information that is accessible to and understandable by the people who need it the most.